“You Speak and Nobody Hears”: The Racialisation of Pregnancy and Birth in the UK, Eli Ansari and Katherine Maslowski

In this blog Elis Ansari  and Katherine Maslowski reflect upon their chapter which focuses upon the pregnancy and birth experiences of people from ethnic minority groups,  “You Speak and Nobody Hears”: The Racialisation of Pregnancy and Birth in the UK.

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Maternity care in the UK has evolved significantly over the last 150 years. We have moved from home births with traditional birth attendants, to an increasingly medicalised system where hospital births are now the norm. While many of these changes have improved outcomes for mothers and babies, women's experiences and preferences have often been sidelined in favour of standardised clinical protocols. In recent years, maternity care in the UK has continued to evolve, with greater focus on patient safety (including in response to the Ockenden and Kirkup reviews into maternity care failures and the ongoing National Maternity and Neonatal Investigation), mental health, and perinatal inequalities. Despite overall improvements in maternal health, racial disparities are increasingly visible, with Black and Brown women consistently facing significantly higher risks of maternal mortality, poorer care experiences and health outcomes. Whilst the edited book as a whole explores in detail the experiences and invisibilisation of differing groups of women and birthing people who access maternity care services, our chapter focusses on the experiences of women and birthing people from ethnic minority groups who are often starkly invisibilised when it comes to choice and consent. In doing so, it explores the prejudice and bias entrenched in a system that purports to care for the people it whom in fact it often silences.

Despite technological and medical advancements, pregnancy and childbirth remain dangerous journeys to embark upon and there is still a risk of serious complication or death. For this reason, among many others, consent and choice are paramount within the field of maternity care. Pregnant people are risking their health, and even their lives, to have a child, and it follows that they should be the central decision-maker in their own care. The law concurs, requiring informed consent prior to any medical examination, intervention or treatment. Proceeding without consent constitutes a tort or crime.

Reports such as Birthrights' Systemic Racism, Not Broken Bodies (2022) and the MBRRACE studies have pushed equity and human rights to the forefront of policy debates. In this chapter, we explore the findings of the Birthrights’ report, as they relate to choice and consent in maternity care. We examine the undeniable evidence that systemic racism is contributing to negative experiences and health outcomes for Black and Brown women and birthing people and their babies. The experiences of Black and Brown women and birthing people accessing maternity services today is set within the historical context of the development of medical obstetrics and the racial stereotypes, discrimination and experimentation that have developed within this field of medicine.

The Birthrights report examined over 300 testimonies—women and birthing people sharing what it felt like to be overlooked, disbelieved, coerced, and harmed in maternity settings. These accounts consistently described experiences where pain was dismissed, autonomy was curtailed, and racialised assumptions shaped the care provided. Crucially, the report asserts that poor outcomes for Black and Brown women and birthing people are not simply a result of “broken bodies”—a harmful and persistent myth—but are products of systemic failings.

The themes discussed within our chapter include dehumanisation, being ignored and/or disbelieved, and consent and coercion. Our chapter presents a link between historical racial injustice and the issues faced by Black and Brown women and birthing people in maternity care today.  We explore how Black and Brown people being framed as other negatively impacts their care. We argue that this framing is deeply entwined with the roots of modern gynaecology, forming the basis of structural racism within the maternity care system. Black and Brown people are removed from the process of consent and their experiences as knowers of their own bodies are disregarded.  The development of this chapter highlighted to us the deeply entrenched racism that persists in the UK today. The treatment of Black and Brown women and birthing people in maternity care mirrors the prejudices faced by this group in society. We are increasingly exposed to rhetoric that others, silences and invisibilises people in marginalised social groups in the UK. The discrepancies between consent experiences of Black and Brown people and their white counterparts are unacceptable and addressing these should be a priority for everyone who is involved in maternity care.

The law specifies that consent and individualised care are required for all; however, in practice this requirement is not applied equally. In order to dismantle the current system and end the cycle of violence that is killing Black and Brown people, a real attitudinal change is required. The first step towards this change is to listen to the silenced voices of Black and Brown people.